If It Quacks Like A Duck...

I recently received a bill from Jessica's group home for cable TV services in excess of the basic 99 channel service.  Although the group home company had been paying for the extra service for years, it was recently decided that residents would now be responsible for the extra $20 a month.  Unfortunately, Jessica does not have the extra $20 a month from her SSI payment.

When I quizzed the group home manager why Jessica needed all the extra channels, she told me that the staff usually had Jessica watch TV in her room rather than in the common area (where the TV does have extended cable).  Upon further questioning, I was told Jessica was encouraged to watch TV in her room because if everyone was in the same room, agitation and aggressive behaviors would be seen in many of the group home residents.  The staff's solution to avoiding those negative behaviors was to isolate some of the residents.  That doesn't sound like a positive approach to behavior management...in fact, it sounds like seclusion, bordering on restraint to me.

Seclusion and restraint refer to safety procedures in which a person is isolated from others (seclusion) or physically held (restraint) in response to serious problem behavior that places the person or others at risk of injury or harm.  My concern is that these procedures are prone to misapplication and abuse place the group home residents at equal or more risk than their problem behavior.  To break it down further, I am concerned that:

• Seclusion and restraint procedures are inappropriately selected and implements as "treatment" or "behavioral intervention", rather than as a safety procedure.
• Seclusion and restraint are inappropriately used for behaviors that do not place the person or others at risk of harm or injury, for example non-compliance, disruption, or threats.
• Residents, peers, and/or staff may be physically hurt or injured during attempts to conduct seclusion and restraint procedures, and that the resulting injury will be attributed to the negative behaviors of the resident - Jessica, in this case.
• Risk of injury and harm is increased because seclusion and restraint may be used by staff that are not adequately trained.
• Use of seclusion and restraint may inadvertently result in reinforcement or strengthening of the problem behavior.  I strongly believe this is the case with Jessica.
• Seclusion and restraint are used independent of comprehensive, function-based behavioral plans and positive behavior supports.

I agree completely with the group home manager that Jessica can present with negative, sometimes aggressive behaviors.  I know that other residents in the group home also present with similar behaviors.  But is isolation/seclusion the best response in such a situation?  Or is it being used just because it makes life easier for the staff?

I think I know the answer to that.....